The present invention relates to surgical instruments that are angulated to improve utilization and efficiency of use during surgical procedures, primarily internal procedures.
Heretofore, surgical clamps and needle holders have taken the shape of straight, elongated scissors type instruments which include two arms that are pivotally associated at a lock box with the arms lying in a single common plane. For certain such instruments a slight curvature has been presented at the distal tip of same. While the use of such prior art instruments has been great, surgeons using same have experienced limits in occlusion of blood vessels and the like with the clamps, particularly in areas deep, remote and obscure from the surface of the surgical wound. In similar fashion, surgeons utilizing the needle holders or needle clamps have experienced difficulty in suturing within the surgical wound due to the planar elongated nature of the prior art holders, even those which possess a slight curvature of the jaws at the distal end of the instrument.
One particular disadvantage noted with respect to the prior art, conventional instruments is obstruction of the work field. The planar instruments must by nature extend angularly inwardly with respect to the wound and generally across same at the surface, whereby a significant visual blockage of the wound is present, notably that point exactly where the suture is to be produced or the clamp applied.
The surgical instruments of the present invention overcome the disadvantages noted with respect to conventional instruments. Particularly, utilization of the angulated needle holders of the present invention permits easy rectrograde suturing in the placing of posterior row sutures in anastomosing blood vessels, bowel, ureter, and the like. Additionally, when suturing toward oneself, pronation, supination, flexion, extension, adduction, and abduction with actual cicumduction are easily accomplished, such as when suturing the posterior wall of an aortic graft to the aorta. The full range of motion in circumduction is not permitted with a non-angulated needle holder, though with angulated instruments of the present invention, both antegrade and rectrograde suturing can be performed without compromising or restricting circumduction movements which are necessary in the performance of the operative procedures.
By way of explanation as to suturing, the chief joint involved is the wrist joint, with the elbow joint, carpometarcarpal joint, metacarpophalangel joint and shoulder joints contributing synergistically thereto, thus permitting movements necessary in performance of operative procedures.
The wrist joint consists of a radio-carpal, carpal, midcarpal, metacarpal, and distal radial ulnar joint. The radio-carpal joint is disarthroidal, ellipsoidal, in which the concavity formed by the articular surface of the radius and articular disc articulate with the convex surface of the carpal navicular, lunate and triquetral bones, thus allowing flexion, extension, abduction (radial deviation), and adduction (ulnar deviation), thereby permitting circumduction of the hand at the wrist joint.
The capsule of the radiocarpal joint extends from the lower part of the radius and ulna and attaches to the volar surfaces of the navicular, lunate, and triquetral bones. Two ligaments contribute to the stability of the wrist joint, namely the radiocarpal collateral ligament and the ulnar carpal collateral ligament. The radiocarpal extends between the radial styloid and the navicular, while the ulnar collateral attaches between the styloid of the ulna and the triquetral and pisiform bones. The distal radial ulnar joint of the wrist and the proximal radial ulnar of the elbow permit pronation and supination by way of the pronator teres and pronator quadratus muscles along with the supinator and the biceps muscles.
The radio-ulnar joints permit actual rotation, that is pronation and supination, while muscles on the radio-carpal permit flexion, extension, abduction, and adduction.
Movements of the wrist in exerting flexion and extension is through the transverse axis, and radio-carpal deviation is through an anterior-posterior axis. A combination of these movements with pronation and supination allows circumduction of the hand. The range of motion at the metacarpophalangeal joint in flexion is 60 degrees and about 70 degrees in extension, while radial deviation (abduction) is about 20.degree., and ulnar deviation (adduction) is about 30.degree.. Pronation and supination from the neutral position is about 80.degree. and occur chiefly at the proximal and distal radioulnar joints. Flexion and extension, especially volar flexion, is accentuated by the gliding movement between the proximal and distal rows of the radiocarpal bones at the midcarpal joint of the hand and affords elasticity thereto.
Factors limiting abduction (radial deviation) of the hand at the wrist joint is the styloid process of the radius and the ulnar collateral ligament. Ulnar deviation is more extensive because the radial collateral ligament is weaker than the ulnar collateral ligament, and the styloid process of the ulnar is shorter. In radial deviation, the stronger ulnar collateral ligament and the longer styloid process of the radius restrict abduction due to the greater multangular abutting against the radial styloid.
Operative techniques in suturing or the like are chiefly performed by virtue of articulation at the radiocarpal and proximal distal ulnar carpal joints with synergistic assistance from other joints of the upper extremity as mentioned above. When utilizing instruments of the present invention, the surgical techniques and dexterity are improved leading to more efficient surgical performance as opposed to use of the straight, prior art instruments which do not allow the same degree of freedom of movement. Particularly, from a functional viewpoint, when utilizing a straight needle holder, the hand does not assume the normal position of function, particularly in retrograde suturing, i.e., suturing away from oneself, while conversely a proper attitude is available with instruments of the present invention.
In similar fashion with respect to an angulated surgical instrument of the present invention when the surgeon grasps the clamp between the thumb and volar surfaces of the phalanges, vascular clamps or hemistats according to the present invention extend downwardly into the surgical wound with the distal section of some extending transverse to a vertical axis extending into the wound, whereby the clamping jaw may be more efficiently utilized by the surgeon. Such, for example, permits tangential partial occlusion of the Vena Cava and the Aorta in cases of trauma, without totally occluding blood flow. In the case of the straight vascular clamps, such utilization is not practical due to planarity and length of the instrument. Likewise, the angulated distal tip or jaws of the surgical instrument according to the present invention due to the angulated sections enables the surgeon to more effectively utilize same in virtually all surgical procedures in which a vascular clamp or the like would be utilized.
There is no known prior that is believed to anticipate or suggest the angulated surgical instruments of the present invention.